MedicalResearch.com Interview with:
Julie Silver, MD
Associate Professor and Associate Chair
Department of Physical Medicine and Rehabilitation at Harvard Medical School and
Staff physician at Massachusetts General
Brigham and Women’s and Spaulding Rehabilitation Hospitals
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are many documented disparities for women in medicine that include promotion and compensation. For physicians in academic medicine, both promotion and compensation may be directly or indirectly linked to publishing. Similarly, opportunities that stem from publishing such as speaking engagements, may be affected by a physician’s ability to publish.
For more than twenty years, there have been reports of women being underrepresented on journal editorial boards and gaps in their publishing rates. For example, a report titled “Is There a Sex Bias in Choosing Editors?” by Dickersin et al was published in JAMA in 1998 and made a compelling case for bias. Moreover, the authors noted that “a selection process favoring men would have profound ramifications for the professional advancements and influence of women”. Despite a steady stream of reports over the years, gaps have not been sufficiently addressed, and in 2014 Roberts published an editorial in Academic Psychiatry titled “Where Are the Women Editors?”. The 2017 review by Hengel titled “Publishing While Female” highlights many of the gaps, disparities and barriers for women in medicine.
Conventional reasons for disparities, such as there are not enough women in the pipeline or women do not want to conduct research or pursue leadership positions, are simply not valid. Therefore, it is important to look at other barriers, such as unconscious (implicit) bias that may affect the editorial process.
In this study, we analyzed perspective type articles from four high impact pediatric journals. We selected pediatrics, because most pediatricians are women, and therefore there are plenty of highly accomplished women physicians. We found that women were underrepresented among physician first authors in all of the journals (140 of 336 [41.7%]).
We also found that underrepresentation was more pronounced in article categories that were described as more scholarly (range, 15.4%-44.1%) versus narrative (52.9%-65.6%).
MedicalResearch.com: What should readers take away from your report?
Response: Although all four journals are led by male editor-in-chiefs, gender at the helm may or may not be a factor. Regardless of gender, we hope that all medical journal editors will use metrics to identify gaps and will make a much greater effort to address bias in the editorial process. Efforts should be made for all medical specialties and with every type of article.
In this study, we included a 6-step strategy that was previously published by some of the authors on this study in a report titled “Where are the Women?” in the journal PM&R.
This strategy calls for:
(1) examining gender diversity and inclusion data;
(2) transparently reporting the results to stakeholders, including medical schools and academic medical centers;
(3) investigating less than proportionate inclusion of women;
(4) implementing strategies to improve inclusion; (5) tracking outcomes; and, (6) publishing the results.
Our study concludes, “Transparency to all stakeholders regarding reporting disparities, interventions, and outcomes is a hallmark of best practices for diversity and inclusion efforts.”
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We hope that this study will encourage further research that focuses on both medical journals and societies and their role in addressing workforce disparities.
MedicalResearch.com: Is there anything else you would like to add?
Response: Notably, all four journals have formal affiliations with medical societies that physicians belong to ostensibly to support their careers. Both physicians and their employers financially support medical societies through membership and other fees. Medical societies must be accountable to their members and use their influence to ensure equitable inclusion for all underrepresented physicians. This includes re-evaluating their affiliations with journals or other organizations that are not actively and transparently addressing workforce disparities.
Silver JK, Poorman JA, Reilly JM, Spector ND, Goldstein R, Zafonte RD. Assessment of Women Physicians Among Authors of Perspective-Type Articles Published in High-Impact Pediatric Journals. JAMA Network Open. 2018;1(3):e180802. doi:10.1001/jamanetworkopen.2018.0802
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